Tobacco Education and Lung Health Study (TEAL)
- Conditions
- Smoking Cessation
- Interventions
- Behavioral: E-Referral to the Tobacco QuitlineBehavioral: Phone-based Tobacco Treatment, Nicotine Replacement, and Stepped Care Intervention
- Registration Number
- NCT06290869
- Lead Sponsor
- Georgetown University
- Brief Summary
Primary Objective To compare two smoking cessation interventions among individuals undergoing lung cancer screening. Primary outcomes are: 3-month self-reported abstinence from cigarettes and 6-month self-reported and bioverified abstinence from cigarettes.
Secondary Objectives 1) To evaluate reach and engagement overall and by subgroup (e.g., race and ethnicity, underinsured, readiness to quit). 2) To conduct an economic analysis to evaluate intervention costs from the health system perspective.
- Detailed Description
Providing smoking cessation treatment in conjunction with the recently expanded lung cancer screening guidelines is estimated to substantially reduce lung cancer deaths and increase life-years gained compared to conducting lung screening alone. Although CMS recommends that individuals undergoing lung screening who currently smoke are offered cessation treatment, there are multiple barriers to treatment delivery. Improving the evidence-base of cessation treatment for patients undergoing lung screening and methods to promote the systematic uptake of cessation treatment into routine practice, particularly among diverse populations, is essential for realizing the maximum benefit of lung screening. Guided by the Practical, Robust, Implementation \& Sustainability framework, we will extend our prior work (CA R01207228). We propose a health system-level, pragmatic, randomized trial to compare the effectiveness of two evidence-based cessation treatments, with implementation strategies designed to address barriers to reach and engagement, particularly among underserved groups (e.g., racial and ethnic minority groups, underinsured patients, and patients not ready to quit) who are less likely to receive cessation treatment. To maximize generalizability to other health systems and to improve reach among heterogeneous groups, all patients scheduled at one of the 10 lung screening sites at MedStar Health, the largest and most diverse health system in the Mid-Atlantic, will be identified via the EHR, contacted for enrollment using an opt-out approach, and randomized to: 1) Quitline E-referral (QL-E; N=594) via the EHR and quitline integrated system, including proactive outreach and standard phone-based counseling + nicotine replacement provided by the quitline vs. 2) MedStar Health System (MHS; N=594), centralized, phone-based + NRT intervention adapted and improved from our prior trial, with a randomized stepped care intervention for those who are not abstinent at 3 months. Specific aims are: 1. To compare e-referral to the Quitline vs. the centralized Health System intervention. Primary outcomes are: 3-month self-reported abstinence from cigarettes and 6-month self-reported and bioverified abstinence from cigarettes. We will assess intervention mediators (e.g., treatment engagement) and moderators (e.g., readiness to quit) at 6-months. 2. To evaluate reach and engagement overall and by subgroup (e.g., race and ethnicity, underinsured, readiness to quit) and using mixed-methods to understand the contextual factors related to the feasibility and acceptability of the interventions and implementation strategies. 3. To conduct an economic analysis to evaluate costs, average and incremental cost per quit, and budget impact of the intervention at 3- and 6-months from the health system p0erspective. Proposal strengths include testing the effectiveness and economic outcomes of two cessation interventions while simultaneously laying the groundwork for future implementation within this and other diverse health systems. Our innovative approach capitalizes on the EHR for recruitment, provides multilevel training focused on diverse populations, and accounts for intervention context to inform future care delivery.
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 1188
- eligible for a screening or diagnostic scan,
- USPSTF eligibility criteria (50-80 years old and >20-pack years);
- currently smoking cigarettes (>1 in the past 30 days);
- English speaking;
- able to provide meaningful consent.
- prior lung cancer,
- hearing impairment,
- cognitive impairment,
- household member already enrolled.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description E-Referral to the Tobacco Quitline E-Referral to the Tobacco Quitline Standard tobacco quitline protocol, including coaching, nicotine replacement, and web-, and text-based resources. MedStar Health System Phone-based Tobacco Treatment, Nicotine Replacement, and Stepped Care Intervention Phone-based Tobacco Treatment, Nicotine Replacement, and Stepped Care Intervention
- Primary Outcome Measures
Name Time Method Biochemically verified smoking abstinence--continued MHS arm vs Stepped Care 6-month assessment Biochemically verified 7-day abstinence rates between the Stepped Care arm and the Continued MHS arm
Biochemically verified smoking abstinence- MHS vs. QL-E arms 6-month assessment Biochemically verified 7-day point prevalence abstinence rates, comparing the Health System (MHS) arm and the Quitline (QL-E) arm
- Secondary Outcome Measures
Name Time Method cigarettes per day 3-month and 6-month assessments number of cigarettes smoked per day
Costs per arm from the health system perspective Assessed through study completion, an average of six months. Staff time costs; fixed costs, and variable costs
Patient reach and patient engagement Assessed through study completion, an average of six months. Reach: % of eligible smokers enrolled in trial; Engagement: % who receive the intervention, both overall and among subgroups
self-reported smoking status 3-month and 6-month assessments self-reported abstinence (defined as in the past 7 days and in the past 30 days)
readiness to quit 3-month and 6-month assessments readiness to quit (defined as ready to quit in the next 30 days, the next six months, or not ready to quit)
Trial Locations
- Locations (1)
Georgetown University Medical Center
🇺🇸Washington, District of Columbia, United States